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The Chief Medical Officer: A Critical Success Factor

Medical Staff Affairs Monthly, June 10, 2009

There has been extensive coverage of the multitude of changes occurring in contemporary healthcare. These include the exponential increase in transparency and public accountability; the need for boards to focus as much energy on quality outcomes as on financial performance; the move toward a myriad of new medical staff models to help deal with challenges of patient safety, high reliability, cost containment, and accountability; and the need for physician leadership education, development, and training. In working with many successful organizations around the country, I have observed the following: a physician executive model, anchored by an experienced chief medical officer (CMO) with the right temperament, is helping multiple organizations implement the changes needed to succeed in this new and challenging healthcare environment. Every day, these dedicated physician executives pick up the mantle and help drive the focus on quality, high reliability, and demonstrable clinical outcomes for their organizations. So what distinguishes an effective and respected CMO?

First, the CMO is a clinician. They have clinical credibility and understand the practice of medicine because they too were practitioners—although the CMO job is increasingly a full-time executive role. They understand the language and the world of clinicians because they lived in it and can empathize with frontline physicians who provide patient care in an increasingly unforgiving environment. In teaching institutions, there is the additional need to be a statesperson in keeping the relationship between academic and private practitioners a healthy and collaborative one.

Second, they have not only on-the-job experience, but also formal training in business, management, and leadership. Understanding the practice of medicine is critical, but the CMO must also understand the business of medicine both from a private practice as well as an academic perspective, depending on the setting. Credibility is required not only in the medical staff lounge, but also in the C-suite and the boardroom. The effective CMO is able to bridge the chasm between cost and quality because they understand both sides of the equation and know that, like a balance sheet, assets must equal liabilities. Neither a management degree nor a business degree alone is sufficient; real-world experience in healthcare organizations is essential. Specific skills are that the CMO must be able to credibly present and administer the agenda of quality to the governing body while supporting an economically viable budget, as well as the organization's strategic plans.

General skills include the following:

Knowledge and appreciation of politics without being political is vital.

The ability to balance the New England Journal of Medicine with The Wall Street Journal is invaluable.

The skill to effectively translate "clinical-ese" and "administrative-ese" to all stakeholder groups is a core competency.

The ability to be comfortable living in multiple worlds without being wholly part of either defines one of the major challenges of the position.

Organizations such as The Greeley Company and the American College of Physician Executives are an excellent source of training in the management, leadership, and executive skills for this growing cadre of physician leaders. The latter also affords opportunities for ongoing mentoring and networking to support these physician executives.

Third, today's effective CMO is the "bridge over troubled waters" in developing and implementing a comprehensive strategic medical staff development plan. This is fundamentally important in an era characterized by fragmenting relationships between medical staffs and hospitals driven by impacting forces that include economics, technology, generational changes, and transparency. There is a growing challenge of the traditional self-governed medical staff model to be able to effectively meet ongoing vigorous and unending demands. The traditional role of the CMO is to assist medical staff leaders in carrying out their board-delegated responsibilities for credentialing, privileging, and peer review. Clearly, this remains an underlying pinning of the CMO role. In addition, however, the CMO also needs to work with physicians to identify and implement new models to help both physicians and hospitals succeed. This can range from legal support of private practices all the way to oversight of fully employed and contracted clinical programs. The key is to enhance mutually beneficial strategic goals by identifying appropriate clinical and business opportunities. Then implement them!

The fourth characteristic of today's effective physician executive CMO is to be the resounding drumbeat for establishing safe organizations with high-reliability patient care. This means using evidence-based approaches, where available, to identify best practices. It also means eliminating unnecessary variation and driving the improvement of clinical outcomes, not simply standardization. The effective CMO recognizes and embraces the concept of relationship-based care that acknowledges the effectiveness of a model based on a well-coordinated team that collaborates on clinical care to consistently drive the best outcomes. Accurate physician outcome data must be available for use in a timely manner to facilitate the education of all stakeholders in the care continuum as to the impact of best practices. This can be a very powerful combination of working with both physicians and executive team members to develop systems that link operations, quality, safety, and finance. In particular, this requires a close working relationship with the chief nursing executive and chief operating executive to get the job done.

The fifth factor, albeit more nebulous than the preceding, is absolutely essential for success. It addresses the personality characteristics of successful CMOs. One observer pointed out that all the candidates for a recent CMO search were well qualified by the criteria established for the position, including requisite clinical experience, management education, job experience and so forth. In the final analysis, however, it came down to an element called "chemistry" or "temperament." The successful CMO possesses qualities that include being persuasive, communicating excellently, exhibiting passion about quality, possessing trustworthiness, being viewed as supportive of the medical staff, and exuding credibility. Simultaneously, the CMO should not be perceived as being overbearing, domineering, indecisive, egotistical, or as being a politician. One hospital CEO described the amalgamation of qualities in a successful CMO as being able to "lead quietly." This element can be summarized as making a good cultural fit. The failure of an individual CMO, or the CMO role itself in an organization, can often be traced to underestimating the importance of these characteristics.

There is little doubt that well-chosen physician executives can help an organization tremendously in achieving its business, operational, financial, and publicly reported outcomes. Increasingly, more and more hospitals are moving toward physician executive models. This trend has spread from mid- to large-size hospitals down to hospitals of around 100 beds. Some hospitals continue to operate without a CMO position but these are becoming fewer and fewer with time. The decreasing involvement of medical staff members in the activities of the hospital precisely at a time when hospitals have an increased need for physician participation is inevitably leading to new models of relationships between physicians and hospitals. The physician executive model, done properly, anchored by a seasoned and experienced CMO, can be a powerful determinant of success for the organization going forward.

Until next time, be the best that you can be.

William K. Cors, MD, MMM, FACPE, CMSL
Vice President
The Greeley Company

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